Authors: Jones, Miren I¹; Greenfield, Sheila M¹; Bray, Emma P¹; Baral-Grant, Sabrina¹; Hobbs, FD Richard²; Holder, Roger¹; Little, Paul³; Mant, Jonathan⁴; Virdee, Satnam K¹; Williams, Bryan⁵; McManus, Richard J²

Source: British Journal of General Practice, Volume 62, Number 595, February 2012 , pp. e135-e142(8)

Publisher: Royal College of General Practitioners

Abstract:

Background:

Self-management of hypertension, comprising self-monitoring of blood pressure with self-titration of medication, improves blood pressure control, but little is known regarding the views of patients undertaking it.

Aim:

To explore patients' views of self-monitoring blood pressure and self-titration of antihypertensive medication.

Design and setting:

Qualitative study embedded within the randomised controlled trial TASMINH2 (Telemonitoirng and Self Management in the Control of Hypertension) trial of patient self-management of hypertension from 24 general practices in the West Midlands.

Method:

Taped and transcribed semi-structured interviews with 23 intervention patients were used. Six family members were also interviewed. Analysis was by a constant comparative method.

Results:

Patients were confident about self-monitoring and many felt their multiple home readings were more valid than single office readings taken by their GP. Although many patients self-titrated medication when required, others lacked the confidence to increase medication without reconsulting with their GP. Patients were more comfortable with titrating medication if their blood pressure readings were substantially above target, but were reluctant to implement such a change if readings were borderline. Many planned to continue self-monitoring after the study finished and report home readings to their GP, but few wished to continue with a self-management plan.

Conclusion:

Participants valued the additional information and many felt confident in both self-monitoring blood pressure and self-titrating medication. The reluctance to change medication for borderline readings suggests behaviour similar to the clinical inertia seen for physicians in analogous circumstances. Additional support for those lacking in confidence to implement prearranged medication changes may allow more patients to undertake self-management.

Keywords: family practice; hypertension; qualitative research; self blood pressure monitoring

Document Type: Research article

DOI: http://dx.doi.org/10.3399/bjgp12X625201

Affiliations: 1: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK 2: Primary Care Health Sciences, University of Oxford, Oxford, UK 3: School of Medicine, University of Southampton, Southampton, UK 4: General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK 5: NIHR Biomedical Research Unit for Cardiovascular Diseases and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

Publication date: 2012-02-01

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• The British Journal of General Practice is an international journal publishing articles of interest to family practitioners and primary care researchers worldwide. The journal's 2010 Impact Factor is 2.07, making it the world's second most highly cited journal of general practice and primary health care.
  
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